Health Analytics to Give Patients Their Voice

That's what I couldn't help thinking -- to the tune of the '70s Helen Reddy classic, "I Am Woman," of course -- while listening in on the 11th annual SAS Health Analytics Executive Conference yesterday. As data and analytics advance, healthcare, like retail and banking before it, is going to take on a decidedly more consumer orientation, in look, feel, and practice. And, as a result, patients truly will be empowered.

Take health portals, for example. One day, they should be to patients what Zulily is to the modern mom-cum-shopping maven, suggested keynote presenter Farzad Mostashari, who, as I mentioned yesterday, is a visiting fellow at Brookings Institution and former national coordinator for the federal government's health IT program. (See: Advice From a Health IT 'Data Ferret'.)

I don't shop at Zulily, but apparently it's the place to go even if you don't know what you want to buy because, as Mostashari said, it's "damn good" at figuring that out for you. If you're the mother of a second-grade girl, for example, you're going to see a picture of a 7-year-old wearing a sundress when you click on the site. But if you're the mother of a 3-year-old, you're going to see that sundress on a toddler. "What healthcare institution website do you know of that shows you something different depending on who you are?" he asked rhetorically.

Zulily is in constant learning mode. It serves up those sundresses on appropriately aged girls because its predictive engine tells it that moms are more likely to buy when they see clothing on the same-aged kids as their own. Whether the prediction pans out or not, Zulily will learn from the interaction and apply that knowledge in a continuous cycle.

It's about time that health organizations did the same, Mostashari said. "Every other part of the economy does this except for healthcare."

Same goes for randomized A/B trials, in short cycles, he added. "We need some of that in healthcare."

In a sense, healthcare needs to get "Uber-ized" -- one click, and the car comes, easy as that. Using smartphone apps, for example, healthcare winners "will reduce the friction, and increase the loyalty, the engagement, and the communications. They'll make it easier for people to do the right things and improve their outcomes," Mostashari said.

Terhilda Garrido,
Kaiser Permanente

Certainly, increasing the quality of care, while better managing or reducing the cost of that care, is a drumbeat heard throughout the healthcare industry, agreed Terhilda Garrido, vice president of health IT transformation and analytics at Kaiser Permanente, during a panel discussion on organizational change.

Many industry watchers, including Mostashari, look to Kaiser Permanente for the next wave of innovation when it comes to data-driven patient outreach. That's because it has the advantage of being a three-in-one organization -- a health insurance provider, an integrated hospital system, and a set of medical groups. "Obviously we have provider data and the healthcare continuum under one roof, so that gives us a wonderful advantage," Garrido said.

And the future for Kaiser Permanente, she added, is in "collaborating out to the patient."

Kaiser Permanente feels it must be able to collect more from and have ready access to data providing the patient's own perspective -- meaning, patient-reported outcomes, with no touchpoint left untapped. It wants sensor data culled from those FitBits and other remote monitors, as well as anecdotal information shared over social media, for example, Garrido said. This kind of outreach and collaboration with patients, she added, takes health organizations beyond their traditional borders.

"We need to have the patient as an active part of the healthcare system and data. That would be really helpful, and it's the direction we're pursuing."

WellPoint, the Blue Cross Blue Shield license holder in more than a dozen states, feels much the same, said Patrick McIntyre, senior vice president of healthcare analytics for the health plan provider. Patients need to be the winners of health analytics and the affordable care mandate -- even if there are no others, he said.

Not everybody will thrive as the health industry transforms itself around patients, McIntyre said. "The people who will be the winners, outside of the patients, are those who realize that the world has changed. Consumers will be driving healthcare in this country."

Personally, as I suspect most do, I love the idea of patient empowerment. But like that woman of the song, will our ability to roar come only after considerable pain? How high of a price -- on privacy, say -- will we need to pay? Share your thoughts below.

Good plan, PC! You've reminded me of one a post-surgery recovery I experienced once. I'd been over-anesthesized, and a routine in and out of the post-op room turned into a long, drawn-out process as they tried to stabilize me. (It was horrible at the time, but I can laugh about it now. Everytime the blood pressure cuff would inflate, my body would go into spasms. Of course they couldn't take off the cuff, because they needed the vitals, but I felt like Pavlov's dog.) The nurses were fine at my bedside, but when they weren't they spent the time grousing that the recovery was taking so long and one was complaining that her shift had ended, and everytime somebody new walked in, she'd be like, what's going on in here... what's the delay?) HELLO PEOPLE, I can hear you! So not only was I scared out of my mind (I couldn't feel anything below my neck), I was also feeling guilty because I was causing these nurses an inconvenience. And of course I didn't want to say anything that would change their irritation into anger, so I kept quiet. That's not how a patient should feel!

Your example is poignant because it is so counter to the detached professionalism that is common in hospitals.

I've been in hospitals as much as any healthy person who doesn't work there and I can only think of one interaction like yours: it was late in the day and my procedure was taking longer than expected. The doctor had happily mentioned earlier that he had tickets to the hockey game, but the happiness disappeared as he found he hadn't scheduled enough time for me.

He didn't mention hockey again, but he did became frustrated and even, I would say, angry as it became clear to both of us that he would be, at best, late to his cherished game. I wanted to say several things - Hey, do you think I want to be here? Who planned this thing anyway, me or you? Can you - ouch - be a little more gentle right there? But my better judgment was not to perturb the scary man with the sharp instruments.

Quite the story. You're even considering the potentially rough day she was having. Before she stormed off, do you think she even considered what a horrific day you been having? This was your child, and naturally, you'd be curious.

I can relate, somewhat. One of my worst nightmares as a newish mother was when my first daughter, then about 6 months old, had a febrile convulsion. We rushed her to the ER, and they proceeded to run a battery of tests. We were there for a couple of hours, and it seemed fairly clear that this convulsion was an anomaly, caused by a fever spike, but still we had to wait on one more blood draw and then the doctor's OK to leave. When the nurse came in to take the baby's blood, I asked in a very calm manner (as I said, all the initial anxiety had subsided) what she was taking the blood for. You see, I'd just read a parenting article encouraging moms and dads to be curious and ask questions of doctors and nurses, etc., about procedures and tests. Well, this nurse went ballastic. She threw down the blood kit and stomped out of the room, saying something along the lines of, "I don't have to deal with this. Does she think I'm doing this for fun?" My husband and I were dumbfounded, not to mention appalled. The behavior was so out of whack with the situation. Maybe the nurse was at the tail end of a double shift, maybe it'd been a really grueling morning in the ER, maybe she was having personal problems.... but whatever the case, she clearly didn't want any parental questioning. We should have just sat there, meekly. I'm happy that happened, though, because clearly she was in a pissy mood and she might have taken that out on my daughter, with an extra hard jab of the needle, rather than on me.

I could easily see him being set aside. Since he was so closely tied, they were so ready to discard his opinion, even a professional one.
The number of things that could rise from better communication...

Mostashari made an similarly interesting point, as well. And that was that doctors and nurses have the tendency to disregard a hospitalized patient's families. They'd rather not deal with them, when in fact they can be quite invaluable in providing insight on patient behavior and help keep the patient from re-admitting. He used his own personal example of dealing with his mother's doctor/nursing staff, all of whom largely ignored him and shooed him away even though he himself is a doctor and so has sound medical knowledge to draw on. He said he often wonders has he been allowed to be more involved would his mother have required a follow-on procedure.

The idea of transparent pricing at the hospital is giving me bad images of a man walking up to a receptionist, and deciding between Kidney Transplant and Knee Surgery to order off of a menu with prices.

I think there is more to it than just price competition. In general, we have too many hospitals and as insurance reform takes hold, the insurance companies will force better outcomes to be rewarded. This will require better interfaces with patients.

I wonder if health care providers have such a captive audience that they aren't going to pay much attention to patients' voices. Unlike retailers having to stay competitive to attract new customers, hospitals, so far don't advertise prices and readily list their most effective services. I suspect when pricing becomes more transparent, health care will listen more to their patients.

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